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If adults stay up past their bedtime or do not get a good night's
sleep, they are usually worn out the next day. But lack of sleep may
have the opposite effect on a child. As many parents know all too well,
a child who should be exhausted from poor or insufficient sleep at
night may instead be bouncing off the walls the following day,
according to Duke University Medical Center researchers.

Some
parents may suspect that Attention Deficit Hyperactivity Disorder
(ADHD) causes this hyperactivity, when in fact the cause could be a
common sleep disorder, pediatric sleep apnea.

Approximately one
percent of children have obstructive sleep apnea, which is
characterized by loud snoring and periodic breathing interruptions,
often with gasping and snorting noises. Duke researchers believe that
some children who exhibit hyperactive behavior may actually suffer from
this sleep disorder.

Dr. Richard Kravitz, director of Duke's
Pediatric Sleep Laboratory, said physicians have become increasingly
aware of sleep apnea in adults during the past 20 years, but only much
more recently has sleep-disordered breathing in children begun to
receive attention.

Ten or 20 years ago, if a child snored or had
sleep problems, the standard response was, 'Don't worry, he'll outgrow
it,' says Kravitz. "We've come to realize that many kids don't outgrow
these problems, and they're every bit as important and serious as they
are in adults.

"But as any pediatrician will tell you, children
are not miniature adults. Many children have diseases that also appear
in adults but present very differently in kids."

In adults, sleep
apnea can lead to a slowed heart rate and an increase in blood
pressure. In children, however, similar sleep problems can contribute
to abnormal urine production, interruptions in growth hormone secretion
and symptoms of attention deficit disorders, which may include
hyperactive, disruptive behavior.

Diagnosing the cause of the
hyperactivity can be extremely difficult, according to Kravitz, an
assistant professor in Duke's Division of Pediatrics Pulmonary Medicine.

"As
we learn more about ADD (Attention Deficit Disorder) and ADHD, and we
learn more about sleep apnea, we're starting to see overlaps between
the symptoms," Kravitz said. "They're separate conditions, but they
overlap in terms of their symptoms. So it makes it even more
challenging to try to tease out in a child who has trouble
concentrating or is hyperactive, is it ADD or ADHD, is it sleep apnea,
or is it a combination of both?"

The standard diagnostic
examination for sleep-disordered breathing is a sleep test, which can
be administered at home or in a sleep laboratory. Children who display
symptoms of pediatric sleep apnea, such as snoring, snorting or
thrashing in bed, or signs of change in mood or behavior, should be
taken to a pediatrician to determine if a sleep disorder could be the
cause, Kravitz said.